LGU/ CO DOCUMENT CHECKLIST

ANNEX A

LGU / Community Organization Document Checklist

Sanggunian/Board Resolution affirming the interest of the LGU/Local/Community

Organization to apply and authorizing the chief executive to enter into an
agreement with the Board for the implementation of the proposed project
Certified true copies of Accreditation* and SEC Registration/Incorporation papers
(Community Organizations Only)
Organizational Structure (with Officials/Board/Members updated General
Information Sheet)
Audited Financial Statement covering the last three (3) years
Project Proposal
Vulnerability/Risk Assessment/ Hazard Maps/ Relevant documents
demonstrating/ indicating climate risk exposure
Feasibility Study (if applicable)
Administrative Order/Executive Order creating the LGU/ Community Organization
Project Implementation Unit/Team (with the General Information Sheet of the
members)
Minutes and highlights of consultation with stakeholders for the project
development
Database of stakeholders consulted (name, organization, contact details, affiliation)
Sex/ Gender-disaggregated data in proposal consultations and proposal
beneficiaries
Program of Work
Detailed Cost Estimates of the Project
ECC and CNC (if applicable)
Results Framework (milestones, targets and indicators)
Certificate of No Derogatory Record of the officials/board/members.
All other necessary documents as may be required upon evaluation of the
application

* Accreditation under DSWD- COA – DBM Joint Resolution 2014 – 01, DILG Memorandum
Circular 2013 – 70 and CCC Accreditation.
 |PROPONENT’S PROPOSAL

ANNEX B

Proposal Template

(Please submit completed form to ____________________)

SECTION A. BASIC INFORMATION OF THE PROPONENT

Province/City/Municipality
Name of Organization

Authorized Signatory

Contact Person

Income Class

Email

Telephone

Proposal Number Filled by PSF Secretariat

Date of Submission Filled by PSF Secretariat

Date of Receipt Filled by PSF Secretariat

SECTION B. INFORMATION ON THE PROJECT PROPOSAL

1. General Information
Project Title

Project timeline/duration

Project site / Project

location

Project Focus Area AGRICULTURE AND FISHERIES

□ Risk insurance needs for farmers, agricultural workers and other stakeholders
□ Monitoring and forecasting system for pest and disease outbreaks triggered by climate change
□ Improving pest and disease control and prevention
□ Monitoring of vector borne diseases

INFRASTRUCTURE DEVELOPMENT
□ Postharvest (storage, processing, other related facilities)
□ Irrigation system (SWIP, ponds, runoff diversion canals and other _water harvesting systems;
shallow tube wells, etc.)
□ Climate change adaptive transport systems (FMR, trams, etc.)

NATURAL ECOSYSTEMS INCLUDING MOUNTAINOUS AND COASTAL ECOSYSTEMS

□ Watershed management (for watersheds supporting local domestic and irrigation water supply
systems managed by LGUs, cooperatives, farmers’ groups, water districts and national and
 |PROPONENT’S PROPOSAL

other irrigation systems under NIA)

□ Monitoring & risk assessment
□ Forest cover improvement
□ Land use management
□ Livelihood and capacity development for IPs and local communities (watershed management)
□ Resource inventory
□ Ecosystem management (particularly terrestrial and aquatic critical habitats, and protected
areas in general)
□ Monitoring & risk assessment
□ Restoration of degraded areas

INSTITUTIONAL/CAPACITY DEVELOPMENT
□ Improvement in forecasting and early warning systems as part of preparedness for climate-
related hazards at the local and community level
□ Establish/support/strengthen regional and local research/information centers and networks to
support climate change adaptation initiatives and projects
□ Preventive measures, integrative and comprehensive local land use/development planning,
preparedness and management of impacts relating to climate change
□ Contingency planning for droughts and floods in areas prone to extreme climate events.
□ Conduct of assessment of impacts, vulnerabilities and adaptation to climate change impacts
and capability building
□ Advocacy, networking and communication activities in the conduct of climate change
information campaign

□ OTHERS (please indicate)

Implementing Partner (If

any)

Amount of Counterpart
Contribution

Amount of Financing
Requested from PSF

Amount of Other Sources

of Fund (if applicable)

2. Project Background and Rationale (maximum of 750 words)

Provide brief introduction about your project location / area.

What are the challenges being faced that the project wants to address?
How are these challenges connected to climate change?
State relevant climate change scenarios in the local level.
How does the project contribute to climate resiliency?
State the reasons why the said challenges are important to address.
What is the present condition of the beneficiaries of the project?
Why is the project important to the beneficiaries? (Discuss the economic, social and environmental
benefits.)
 |PROPONENT’S PROPOSAL

3. Project Goals and Objectives

State yours goals (Describe the major output of the project).

State your objectives (Indicate the objectives of the project that will help to achieve the goal or major
output).

Objectives Expected output Success Indicators Executor (proponent/partner)

(What is the change that
takes place due to the direct
impact of the project, for
example: human behavior,
environmental
improvement, policy
change or others) (Not more
than 100 words)

Output 1……..
Activity 1.1…
Activity 1.2...

Output 2……..
Activity 1.1…
Activity 1.2...

4. Project Application Effectiveness

What are the inputs of your beneficiaries in the development and success of the project?
What are the inputs of other stakeholders in the development and success of the project?
What are the local/national policies or climate change sensitive local/national development plans
that the project supports?

5. Project Implementation

How can the project be implemented?

What are the strategies you will use to attain the major output?
Will there be an implementing partner? (e.g. organization)
How can the implementing partner, if any, promote success to attain the major output?
 |PROPONENT’S PROPOSAL

6. Environmental Impacts

Does the project have direct/indirect environmental impact?

If yes, identify the safeguards? (securing documents from DENR, etc., )

7. Project Sustainability Plan

Are there follow-up plans after the proposed project? (Kindly indicate)
Is there an exit plan to ensure the continuation or maintenance of the project?
Is there a possibility that your project can also be done in other areas? (Please indicate how)

8. Project Monitoring and Evaluation Program

What is the existing mechanism / system / arrangement of monitoring and evaluation of projects
being implemented in the proponent’s organization?

What is the proposed monitoring and evaluation plan for the project?

SECTION C. INFORMATION OF THE IMPLEMENTING PARTNER

Name of LGU/Organization :
Full Address : (Street, City, Postcode, Province, Telephone, Facsimile, e-mail)
Name and Contact Number of LGU/Organization:
Provide brief information about the agreement with the implementing partner on how the project
will be implemented together. (If applicable)

SECTION C.1
FOR LGUs Only:
Role of the LGU in the project proposal:

SECTION C.2
FOR Organization Only:
Status of Organization:
Accreditation #: Accrediting National Government Agency:
Date of establishment: (Date, Month, Year)
List of Board of Director: (Name/Position)
Director/Chairperson:
Purpose of Organization:
Amount of fund that was managed in the previous year:
Source and amount of fund in the implementation of the last three projects:
Role of the organization in the project proposal:
 |PROPONENT’S PROPOSAL

Reference (Institution or individual that can give more information about your institution)

Reference Name Institution Telephone Email

SECTION D: ATTACHMENTS

Proof of basic information of the Local Government Unit / Local Organization

Work plan (gant chart)
Financial plan
Other PSF required documents
 ANNEX C
Work and Financial Plan Template

SAMPLE FORMAT [WORK PLAN]

Project Title: Project Proposal No.:

Name of Project Proponent:

Project Timeline/Duration:
Brief Description of General Objective of Project:

Brief Specific Objective No 1: Duration of Activity in Months/Quarters

1 2 3 4 5 6 7 8 9 10 11 12

Activity Expected Location Performance Responsible Party Estimated Cost

Output Indicator / Measure / Work
Component
1

Brief Specific Objective No 1: Duration of Activity in Months/Quarters

1 2 3 4 5 6 7 8 9 10 11 12

Activity Expected Location Performance Responsible Party Estimated Cost

Output Indicator / Measure / Work
Component
1

3
 SAMPLE FORMAT [FINANCIAL PLAN]
Project Title: Project Proposal No.:
Name of Project Proponent:

Project Timeline/Duration:
Brief Description of General Objective of Project:

I. Personal Services Quantity Cost

Direct Cost
Salaries
Cost

Indirect Cost

Total for PS

II. Maintenance and Other

Operating Expenses

Direct Cost Supplies

and Materials
Equipments

Total for MOOE

III. Equipment Outlay

Breakdown of
Equipment

Total EO
 ANNEX D

CCC Accreditation Guidelines

for Local/ Community Organizations
Accessing The People’s Survival Fund (PSF)

I. PURPOSE

The People’s Survival Fund (PSF) is an Act that streams financing assistance to the local
government units and Local/community organizations anchored in providing climate change
adaptation activities.

Stated below is the excerpt from the PSF Law, which serves as the basis of the Climate Change
Commission (CCC) in developing the guidelines for the accreditation of Local/Community
organization in order to access the People Survival Fund:

“Section 23, Role of the Commission in the Utilization of the

People’s Survival Fund - where as the Commission shall develop
guidelines to accredit local organizations seeking to access the
fund. Organizations will be accredited based on criteria such as
organizational independence, track record in the community
and/or field of expertise, financial management and participatory
practices.”

II. COVERAGE

Local/community organizations (COs) in all the provinces, cities and municipalities that are
accredited under DILG Memorandum Circular 2013 - 70 and DSWD - DBM - COA Joint Resolution
2014 -01 which intends to access PSF may readily submit proposals to access PSF, provided that
their Certificates of Accreditation is validated by the CCO.
The rest shall be covered by this guideline.

III. DEFINITION OF TERMS

For purposes of Accreditation under this guideline the following terms shall be construed to mean
as follows:

Accreditation - refers to the process by which the CCO shall recognize the Local/community
organization's eligibility to apply for PSF though assessment of their capacity whether the fund may
be entrusted to them to successfully accomplish climate change adaptation projects in a timely,
cost-efficient and transparent manner.

Adaptation - refers to adjustments in ecological, social, or economic systems in response to actual

or expected climatic stimuli and their effects or impacts. It refers to changes in processes, practices,
and structures to moderate potential damages or to benefit from opportunities associated with
climate change. Adaptation measures aim to reduce sensitivities and exposure to hazards, and
enhance adaptive capacity.

Beneficiary - refers to the local community or any of its sectors and members, which is the intended
recipient of the results of the developmental efforts of the Local/community organizations.

Climate Change Office (CCO) - refers to the office created under the Republic Act 9729 that assists
the Commission and serves as Secretariat of the Board.

Commission - refers to the Climate Change Commission

Local/Community organizations - include non-government organizations (NGOs), People's

Organizations (POs), basic sector organizations, cooperatives, trade unions, professional
associations, faith based organizations, media groups, indigenous peoples movements,
foundations, and other citizen's groups, that has maintained a local scope of work and has
established a provincial or municipal operational presence, non-profit and are formed primarily for
social and economic development to plan and monitor government programs and projects, engage
in policy discussions, and intends to participate in climate change adaptation efforts, and are
accredited by the government agencies identified by the board or has undergone the accreditation
of the Commission.

Project - activity undertaken by the beneficiaries which may include soft and hard projects in order
to support climate change adaptation activities of the local governments and communities.

Program - a planned and coordinated set of activities, procedures, and actions intended and
implemented for climate change adaptation purpose.

IV. CALL FOR ACCREDITATION

The processes and procedures stated herein cover local/community organizations who are not
accredited under the accreditation referred above. It shall be operationalized by the Climate
Change Office (CCO) as approved by the PSF Board.

The Climate Change Office shall ensure the implementation of the following:

1. Release of the Notice of Call for accreditation by the CCO, as ordered by the PSF board. It
shall reach all local/community organizations listed in the directory of local/community
organizations of the different National Government Agencies (NGAs), which include, but
not limited to, the suggested names by the Local Government Units, academe and
communities;

2. Ensure the utilization of the different means of communications and publicity (such as mail,
email, website, social media, etc.) by the CCO to invite and encourage Local/community
organizations to apply for the PSF; and

3. Upon the release of the Notice of Call for accreditation, local/community organizations
who are not accredited under the identified government agency submit their certification
from Securities and Exchange Commission and one (1) copy of each of the following
requirements to the CCO:

A. Duly signed letter of application for Accreditation to access PSF;

B. Duly accomplished Application Form for Accreditation with Certification under
oath that all documents submitted in support of the application are authentic and
genuine, and that all statements in the application form and in supporting
documents are true and correct, and the local/community organizations is aware
of, understands, and agrees to abide by, the Accreditation Guidelines of
Local/Community organizations;

C. Duly notarized Organizational Resolution signifying intention to accredit for the

purpose of accessing funds from the PSF signed by the officers and members and
the individual actually filling the application in behalf of the Local/community
organizations;

D. Proof of active coordination with the beneficiaries of the location of the proposed
project (i.e. Signature of any official of the LGUs);

E. Sworn Certification, issued by the chief executive officer or equivalent officer of the
Local/community organizations, stating;

(a) Other related businesses, if any of the directors, trustees, officers or key
personnel of the Local/Community organizations, and the extent of
owner-ship therein;
(b) That the Local/Community organizations is not in default or delay in
liquidating any funds received from any Government Agency;
(c) That none of the incorporators, organizers, trustees, officers or key
personnel of the Local/Community organizations is an agent of, or is
related within the fourth civil degree of consanguinity or affinity to any
CCO official involved in the processing of its accreditation;
(d) That neither the Local/Community organizations nor any of it past or
present directors, trustees, officers, or key personnel has been
blacklisted by any Government Agency; and
(e) That neither the Local/Community organizations nor any of it past or
present directors, trustees, officers, or key personnel has been is a
defendant, respondent or accused in any civil, administrative, or
criminal case arising from or involving the use of public funds received
by the Local/community organizations.

F. Proof of Communication with the LGU that signifies the Local/Community

organization’s effort/actions of coordination with the LGU (i.e. official letters,);

G. Certification of No Derogatory Record or its equivalent, of the officials of the

Local/community organizations, issued not more than three (3) months before the
date of application by the SEC (i.e. through submitted NBI clearance by the
officials;

H. List of Projects and Programs similar/related/supportive to climate change

adaptation frameworks (i.e. following NCCAP, LCCAP, PDP or other climate
adaptation programs) recently implemented and currently being implemented by
the Local/community organizations both funded by any Government Agency and
not, certified under oath by the responsible officer of the Local/community
organizations, particularly indicating:
 • Title of the Project or Program, its commencement and status and List of
Beneficiaries, if any;
• The Government Agency from which the CSO received public funds and
its total amount for the said project;
• The remaining unliquidated portion of said amount, if any;
• The date of commencement of the project or program; and

I. Organizational Chart including an area-based structure, (i.e., presence in the area

where the project will be implemented); brief description go of management and
staff in effective project planning and implementation supported by an organized
working Board; and

J. Audited Financial Statements for past two (2) years.

K. General Information Sheet of the officers, board and members including their
name, contact details, position etc.,

V. ACCREDITATION PROPER

1. The CCO shall review and assess the requirements listed above and conduct of on-site visits
within but not later than ten (10) working days. Upon assessment of the requirements
submitted, it shall present it to the Commission for attestation;

2. Upon attestation of the Commission that the Local/community organizations underwent the
accreditation Guidelines herein set forth, the CCO shall issue a Certificate of accreditation to
access PSF.

3. Local/community organizations who are provided with Certificate of Accreditation may

proceed to submit Project Proposals to access PSF.

VI. COVERAGE AND VALIDITY

1. Coverage

The CCO issued Certificate of Accreditation shall only be for accessing the PSF.

2. Validity

The CCO issued Certificate of Accreditation shall be valid unless revoked in accordance with
the provisions below.

VII. REVOCATION OF ACCREDITATION

A Certificate of Accreditation may be revoked on any of the following grounds:

1. Misrepresenting in, or falsification of, any document submitted in support of the application
for accreditation of the CSO;

2. Failure by the CSO, during the validity period of the Certificate of Accreditation, to submit a
project proposal within one (1) after its issuance;
3. Violation by the Local/community organizations, during the validity period of the Certificate of
Accreditation of any law, rule or regulation involving the use of PSF;

4. Bankruptcy or insolvency of the Local/community organizations; or

5. Revocation, cancellation or expiration of the principal or any secondary registration of the

CSO, or of any material license or permit required by the CSO to operate.

The above-mentioned process is in accordance with the guiding principles of the PSF Board to recognize
participation and involvement of Local/community organizations exhibiting exemplary performance in
internal housekeeping, particularly in areas of planning, fiscal management, transparency, and
accountability and valuing performance monitoring.

Nevertheless, the provisions in this guideline are subject to revision as deemed necessary by the PSF
Board in accordance with prevailing laws.
 APPLICATION FORM
People’s Survival Fund
Application for Accreditation of Local/Community organizations

Application Accreditation No: (filled by PSF personnel)

Date Received: (filled by PSF personnel)

LOCAL/COMMUNITY ORGANIZATION'S FULL NAME:

NAME OF HEAD: ADDRESS:

ORGANIZATION’S OFFICIALS (NAME, DESIGNATION AND CONTACT DETAILS)

REGISTRATION NO: REGISTRATION BODY:

PLACE OF REGISTRATION:

GEOGRAPHIC SCOPE: (WHERE THE ORGANIZATION IS CURRENTLY ACTIVELY OPERATING)

BUSINESS ADDRESS:

TELEPHONE:

EMAIL:

WEBSITE:

NAME OF TREASURER:

MISSION, VISION AND ORGANIZATION DESCRIPTION:

PROJECTS/PROGRAMS RELATED TO CLIMATE CHANGE ADAPTAION:

TOTAL EXPENDITURES IN THE PAST THREE YEARS:

FOCAL POINT CONTACTS FOR THE APPLICATION:

 ORGANIZATIONAL RESOLUTION

A special meeting of the Board of Directors of (NAME OF LO), a non-stock, non-

profit and non-government entity duly established and registered with the Philippine
Securities and Exchange Commission, with address at _____________________;

When this meeting was called to Order on __________________, it was found that a
quorum of the Board of Directors was present and the following resolutions were adopted:

RESOLVED, that [Name of LO] would access the PSF offered by the Climate Change
Commission of which policy guidelines were properly conveyed and understood by this
body;

RESOLVED, that [Name of LO] shall apply for funding to finance the “[Name of the Project]”
which shall benefit ______________;

RESOLVED FURTHER, that [Name of LO] hereby commits to undertake the necessary acts
for the implementation of the Project as provided for in the policy guidelines.

RESOLVED FURTHERMORE, to:

a. Authorize and empower the President to:

i. Apply with the CCC and when necessary, execute deeds and to do all acts
necessary and proper under the premises for the effective and efficient
implementation of the Project;
ii. Enter into agreements with qualified private individuals or corporations, after
public bidding, to execute the Project; and
iii. Together the with the Treasurer, to open a separate bank account to facilitate
the transfer of funds and audit of the PSF utilization;

RESOLVED FINALLY, within the period required, to furnish the CCC with a copy of this
Resolution.

WITNESS, THE SIGNATURES of the undersigned officers and members of (Name of LO)
this _________.
 ANNEX E

Resolution (LGU) Template

Republic of the Philippines Province of [Name of Province] [Municipality/City] of [Name of LGU]

OFFICE OF THE SANGGUNIANG [PANLALAWIGAN/PANGLUNGSOD/BAYAN]

EXCERPTS FROM THE MINUTES OF THE [REGULAR] SESSION OF THE SANGGUNIANG

[PANGLALAWIGAN/PANGLUNGSOD/BAYAN] HELD AT [VENUE OF THE SESSION] ON [MONTH
DAY], 201__.

PRESENT :

Hon. ____________________ Hon. ____________________ Hon. ____________________

Hon. ____________________ Hon. ____________________ Hon. ____________________

Hon. ____________________

ABSENT :

RESOLUTION NO. [_______-20___]

RESOLUTION AFFIRMING THE INTEREST OF THE PROVINCIAL/CITY/MUNICIPALITY TO

AVAIL OF THE PEOPLE’S SURVIVAL FUND LODGED BEFORE THE CLIMATE CHANGE
COMMISSION FOR THE IMPLEMENTATION OF THE “[NAME OF THE PROJECT].”

WHEREAS, [to cite the title, nature and rationale of the proposed project];

WHEREAS, the [Name of the Project] (the “Project”) is included in the Local Climate Change Action
Plan and in the climate change adaptation programs of (Name of LGU);

RESOLVED, thata public consultation was duly conducted among affected and would be affected
areas and people to determine social acceptability of the aforementioned project, a copy of the
pertinent Consultation/Committee Report is hereto attached as Annex A as proof of acceptability of
the project;

WHEREAS, the Republic Act No. 10174, otherwise, known as the People’s Survival Fund, provides
that the said fund shall be used to support adaptation activities of local governments and communities;

WHEREAS, due to financial constraint to finance the [Name of the Project], the
[Province/City/Municipality] of [Name of LGU] needs to avail of the People’s Survival Fund for the
project’s implementation;

WHEREAS, the PSF is lodged before the Climate Change Commission under the Office of the
President;

WHEREAS, the [Province/City/Municipality] of [Name of LGU] would like to access the PSF offered
by the Climate Change Commission of which policy guidelines were properly conveyed and
understood by this body.
NOW THEREFORE, on motion of Hon. [Name of Proponent] duly seconded by Hon. [SB member
who seconded the motion] it was RESOLVED, that the [Province/City/Municipality] of [Name of LGU]
shall apply for funding to finance the “[Name of the Project].”

RESOLVED FURTHER, that the [Name of LGU] hereby commits to undertake the necessary acts
for the implementation of the Project as provided for in the policy guidelines.

RESOLVED FURTHERMORE, to:

a. Authorize and empower the incumbent local chief executive, Hon. [Governor/Mayor] [Name of
LCE], and his successor, for and behalf of the [Name of LGU] to:

i. Apply with the CCC and when necessary, execute deeds and to do all acts necessary and proper
under the premises for the effective and efficient implementation of the Project;

ii. Enter into agreements with qualified private individuals or corporations, after public bidding, to
execute the Project; and

iii. Together the with the Local [Provincial/City/Municipal] Treasurer, to open a separate bank
account to facilitate the transfer of funds and audit of its utilization;

RESOLVED FINALLY, within the period required, to furnish the CCC with a copy of this Resolution.

[UNANIMOUSLY] ADOPTED. [Day Month Year].

I HEREBY CERTIFY to the correctness of the foregoing resolution which was duly adopted by the
Sangguniang [Panlalawigan/Panglungsod/Bayan] during its [regular] session held on [Month day],
201__.

ATTESTED AND CERTIFIED TO BE DULY ADOPTED:

HON. ________________________ Presiding Officer

____________________________ Secretary to the Sanggunian

APPROVED: [Day Month Year]

HON. ________________________ Mayor

 ANNEX F

Resolution (NGO) Template

A special meeting of the Board of Directors of (NAME OF NGO), a non-stock, non-profit and
non-government entity duly established and registered with the Philippine Securities and Exchange
Commission, with address at _____________________;

When this meeting was called to Order on __________________, it was found that a
quorum of the Board of Directors was present and the following resolutions were adopted:

RESOLVED, that [Name of NGO] would access the PSF offered by the Climate Change Commission
of which policy guidelines were properly conveyed and understood by this body;

RESOLVED, that [Name of NGO] shall apply for funding to finance the “[Name of the Project]”
which shall benefit ______________;

RESOLVED FURTHER, that [Name of NGO] hereby commits to undertake the necessary acts for
the implementation of the Project as provided for in the policy guidelines including a public
consultation to be duly conducted among affected and would be affected areas and people to
determine social acceptability of the aforementioned project, a copy of the pertinent Consultation
Report shall be attached in the application as proof of acceptability of the project;

RESOLVED FURTHERMORE, to:

a. Authorize and empower the President to:

i. Apply with the CCC and when necessary, execute deeds and to do all acts necessary and proper
under the premises for the effective and efficient implementation of the Project;

ii. Enter into agreements with qualified private individuals or corporations, after public bidding, to
execute the Project; and

iii. Together the with the Treasurer, to open a separate bank account to facilitate the transfer of
funds and audit of the PSF utilization;

RESOLVED FINALLY, within the period required, to furnish the CCC with a copy of this Resolution.

WITNESS, THE SIGNATURES of the undersigned directors of (Name of NGO) this

_________ day of ___________ 20____.

Republic of the Philippines)

___________, Metro Manila ) S.S.
 ACKNOWLEDGEMENT

BEFORE ME, a Notary Public for and in the City of ______, this _____ day of
______________ personally appeared:

NAME I.D. NO. DATE PLACE

_____________________ _____________ ________ _________
_____________________ _____________ ________ _________

Known to me to be the same persons who executed the foregoing instrument and they
acknowledged to me that the same is their free and voluntary act and deed.

WITNESS MY HAND AND SEAL.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 20__.